Traumatic amputation

Traumatic amputation - the rejection of part or all of the limb (or other part of the body) as a result of mechanical violence. A specific variant of the mechanism of traumatic amputation is the detachment of the limb. There are full and incomplete traumatic amputation. At the last, the severed part of the limb remains attached to the stump with a flap of skin, muscles, or tendons. Traumatic amputation occurs most often as a result of a so-called rail injury, the movement of a train or tramway. Other reasons may be the tightening of the limb in the moving parts of the mechanisms, the falling of a large load on it. There are often amputations for mine-explosive wounds of wartime.

Skin and bone are the most resistant to trauma. Therefore, the muscles, vessels and nerves are smashed in the remaining part of the limb for a longer time than can be judged by the appearance of the cutaneous wound. The skin of the stump is often peeled off a large distance proximal to the wound. Extensive destruction of soft tissues and bones of the stump are characteristic for the action of great severity (in this case, the syndrome of prolonged compression or crush syndrome, crash syndrome), as well as for rail injury may join. For detachment, separation of the segment elements at different levels is characteristic: for example, stumps of nerves and vessels can be located much more proximally than the wound. Overstretched or crushed trunk vessels of the stump are usually thrombosed, only the muscle branches and bone vessels bleed. The wound of the stump is usually highly contaminated.

Complications. The most frequent and dangerous complication is traumatic shock. It is the heavier than the proximal level of traumatic amputation. The most severe, often irreversible shock occurs when both thighs are amputated. The severity of the shock is also affected by frequent injuries of limbs and internal organs (80% of victims with traumatic amputation). Damage to the latter can dominate the clinical picture and determine the prognosis. Other common complications (acute renal failure, fat embolism, thromboembolism) are closely related to the severity of the shock, the usefulness of its treatment and the severity of the injury. The most frequent is septic-septic complications: a purulent-necrotic process in the wound of the stump, osteomyelitis, less often sepsis, anaerobic infection in the stump, tetanus.

Diagnosis. Assess the mechanism of injury, the time elapsed since the injury, the severity of the general condition, the estimated amount of blood loss (by the amount of blood at the scene and on clothes), conduct preliminary diagnosis of possible other injuries. The latter is especially important in the case of a discrepancy in the clinical picture, the severity of the shock, the level of amputation and the type of stump: the emergence of severe shock in the traumatic amputation of the distal extremity segments without crushing the stump tissues always causes the suspect